Page 370 - Abstract Book KONIKA 18

Pediatric Imaging

P-PI-001
Pneumomediastinum in Neonatal Meconium Aspiration Syndrome,
Angel Wings Sign: A Case Report

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Fisaura Unsa , Runi Arumndari , Destya Nora , Yohannes Ricky Permadi , Evita Karianni Bermanshah 1,2
1
Brawijaya Women and Children Hospital and Pediatric Imaging Division, Department of Child Health, Faculty of
Medicine Universitas Indonesia , Jakarta, Indonesia
2
Abstract
Background Pneumomediastinum in neonates is a mediastinal air-leak happens in the after-birth period.
Air leaks occurred when the alveolar ruptured due to imbalance of gradient pressure between alveolar
and surrounding tissues. The air diffused into the interstitial tissue towards peribronchial and perivascular
tissue, then to the mediastinum. In most cases, pneumomediastinum occurred with underlying condition
such prematurity, meconium aspiration, delivery difficulties, pneumonia or using positive pressure during
ventilation. Objective To present the clinical manifestation of pneumomediastinum in term neonate with
meconium aspiration. Case A 40-weeks gestational age male baby was born vaginally with vacuum extraction
in maternity clinic, weighed 3640 grams. The second stage of labor was prolonged 2 hours. Meconium stained
the amniotic fluid with thick-greenish color. He was vigorous but had an episode of subcostal retraction.
CPAP-ventilation was started at PEEP of 8/40%. Patient was transferred to our hospital and the chest X-ray
showed thymus lobes being raised above the heart by mediastinal air; or the angel wings sign. He was treated
with non-invasive positive pressure ventilation (NIPPV) and antibiotic. After 36 hours-life, NIPPV was
changed to the CPAP. At 7 days-life, radiographic evaluation showed regression of the pneumomediastinum.
He was discharged at 9 days-life. Conclusion Pneumomediastinum appears as radiolucent air outlining
the thymus and boosting the thymic tissue upward named the angel wings sign from the chest X-rays. It is
treatable after the underlying condition resolved. After meconium aspiration resolved, pneumomediastinum
was reduced gradually.
Keywords: pneumomediastinum, angel wings sign, neonate, meconium aspiration

P-PI-002
Periventricular Leukomalacia in Neonates:
Recognition by Cranial Ultrasonography
Marissa Anggraeni , Resita Sehati , Evita Karianni 2
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Department of Child Health and Pediatric Imaging Division, Department of Child Health ,
2
Faculty of Medicine, Universitas Indonesia/Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
Abstract
Background Periventricular leukomalacia (PVL) defines as changes in the signal intensity or echogenicity
of periventricular white matter, it can lead to cognitive deficits in premature infants. The incidence was
19.8-34.1%, peaks at 24-32 gestational with birth weight of <1500 g. PVL can be detected by cranial
ultrasonography (CUS) as increasing periventricular echodensities, followed later by cystic formation.
Objective To demonstrate a case of periventricular leukomalacia in neonates detected by cranial
ultrasonography. Case A 2.5-month-old girl (42-43 weeks of postmenstrual age), was referred to undergo
CUS evaluation from social paediatrics clinic due to the result of CUS examination at 34-35 weeks of
postmenstrual showed ventriculomegaly with increasing of periventricular echodensities. The baby was born
premature at 32 gestational weeks (birth weight of 1.450g) from mother with placenta previa, risk of infection.
The baby received surfactant therapy, invasive breathing support, and had history of severe infection during
the treatment. The baby was discharged from hospital at at 37 weeks of post menstrual age and never had
further repeated CUS evaluation. The CUS examination showed small and some extensive periventricular
cystic lesions, classified as a grade II-III bilateral PVL and resolving of grade I left intraventricular hemorrhage
(IVH). Conclusion Screening high-risk preterm infant with CUS recommended at day 4 to 7 and 14 and
at 3 months Once we found increasing of periventricular echodensities, CUS needs to be evaluated in the
next 7 days to diagnosis the PVL grade 1. Infants with PVL require close neurodevelopmental follow-up.
Keywords: periventricular leukomalacia, cranial ultrasonography, preterm baby

322 KONIKA XVIII Abstract Book